By Belinda Luscombe
December 12, 2016

The number of babies born with opioid withdrawal symptoms has grown much faster in rural areas than urban centers, according to a new study, adding a layer of complexity for communities grappling with a scourge that has had an enormous impact on small towns.

Infants born with this condition, known as neonatal abstinence syndrome (NAS), are more likely to have seizures, be of a low birthweight and have problems breathing, sleeping and getting enough nourishment. They can also have tremors, seizures and be impossible to soothe. The condition is caused when their mothers abuse painkillers during pregnancy.

As communities struggle to deal with the spike in the number of their members who are addicted to painkillers—sometimes prescription, sometimes not—patterns are emerging and rural areas appear to be particularly hard hit. More than a fifth of all the newborns with NAS in 2012 to 2013 were from rural areas.

The new study, published on Dec. 12 in JAMA Pediatrics, found that in rural communities, the rate of babies diagnosed with drug withdrawal symptoms rose to 7.5 cases per 1,000 births in 2012-2013, from slightly more than one case per 1,000 babies a decade earlier. The incidence rose in urban communities too—from 1.4 cases to 4.8 per 1,000 births—but the growth in country areas was 80% higher.

“The opioid epidemic has hit rural communities especially hard and we found that these geographical disparities also affect pregnant women and infants,” says Dr. Nicole Villapiano, pediatrician at the University of Michigan’s C.S. Mott Children’s Hospital and lead author of the report, which tracked newborns who were treated for opioid-related issues over a period of 10 years.

A 2014 study by the American Public Health Association found addiction to prescription painkillers was particularly prevalent in Kentucky, West Virginia, Alaska and Oklahoma. Researchers hypothesize that doctors in rural areas prescribe more painkillers because there are more elderly people there, meaning there was a ready supply. They also suggest that country communities had more poverty, creating an opportunity for drug sales to flourish.

Rural areas also have fewer resources to help with opioid addiction, including treatment and addiction services, so the researchers are calling on the government to ensure that rural areas get adequate support as they attempt to address the issue.

“As a nation, there is an urgent need to develop strategies tailored to rural communities focused on prevention and expansion of treatment,” says senior author Dr. Stephen W. Patrick, assistant professor of pediatrics and health policy at Vanderbilt University. “We need to develop means to support rural hospitals, especially critical access hospitals, that are on the front lines in providing care for mothers and infants impacted by the opioid epidemic.”

Even when a baby is born symptom-free, children of addicted parents are still at risk, as illustrated by two recent high-profile cases: one in which police released a photo of adults passed out in their car with a toddler strapped in the back, and another closed-circuit video where a toddler tries to awaken her mother, who has passed out in the grocery aisle.

Authorities have struggled to deal with the prevalence of opioid addiction, sometimes called the pharmageddon.

“This epidemic does not discriminate. All across this country, it is taking good people from good homes and leading them down a trail that often ends in pain and sadness,” FBI Director James Comey said earlier this year at the release of a new film about addiction. “This film may be difficult to watch, but we hope it educates our students and young adults about the tragic consequences that come with abusing these drugs and that it will cause people to think twice before becoming its next victim.”

Contact us at editors@time.com.

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